Most Common Brain Injuries in Babies Due to Hypoxia and Bleeding

MedicalResearch.com Interview with:
“Baby” by Victor is licensed under CC BY 2.0
Dr Chris Gale
Clinical Senior Lecturer in Neonatal Medicine
Imperial College London and
Consultant Neonatologist at Chelsea and Westminster Hospital
NHS Foundation Trust

 

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As part of a drive to make England a safer place to give birth, the Department of Health in England has set a target of reducing the number of babies that incur brain injury during or soon after birth by 20% by 2020 and to halve them by 2030.

Before now United Kingdom health services did not have a standard definition of brain injury in babies and there has been no systematic collection of data for this purpose. With colleagues and in collaboration with the Department of Health, we have devised a practical way to measure the incidence rate of brain injury in babies using routinely recorded data held in the National Neonatal Research Database.

The research estimated that 3,418 babies suffered conditions linked to brain injury at or soon after birth in 2015, which equates to an incidence rate of 5.14 per 1,000 live births. For preterm births (babies born at or less than 37 weeks) the rate was 25.88 per 1,000 live births in 2015, almost six times greater than the rate for full-term births, which was 3.47 per 1,000 live births.

Overall, the research found that the most common type of condition that contributed brain injuries was damage caused by lack of oxygen to the brain, called hypoxic ischaemic encephalopathy; this is seen mainly in term babies. For preterm babies, the largest contributor to brain injuries is from bleeding into and around the ventricles of the brain, a condition called periventricular haemorrhage.

It is also the first time that brain injuries in babies have been measured using data gathered routinely during day to day clinical care on NHS neonatal units. The use of routine data required no additional work for clinical staff and provides a valuable way to measure the effectiveness of interventions to reduce brain injury.

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Personality Changes Can Signal Incomplete Recovery After Traumatic Brain Injury

MedicalResearch.com Interview with:

Prof.dr. J van der Naalt PhD Department of Neurology University Medical Center Groningen Groningen, The Netherlands

Prof J van der Naalt

Prof.dr. J van der Naalt PhD
Department of Neurology University Medical Center Groningen
Groningen, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Mild traumatic brain injury occurs frequently and is one of the leading cause of morbidity in adults worldwide. It is a major social-economic problem with one in three patients had persistent complaints several months after injury that interfere with resumption of daily activities and work.

One of the most important questions concerns the finding that some patients recover without complaints and others do not after sustaining a mild traumatic brain injury. In a follow-up study with more than 1000 participants we found that personality factors are a major factor in the recovery process. In particular coping, that is the way patients adapt to persistent complaints, is important next to emotional distress and impact of the injury.

In an add-on study with fMRI we found that in the early phase after injury, the interaction between specific brain networks was temporarily changed. However, when regarding persistent posttraumatic complaints , specific personality characteristics significantly determine long term outcome.

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New Biomarker Has Potential For Sideline Diagnosis of Traumatic Brain Injury

MedicalResearch.com Interview with:

Dr-Adrian-Harel.jpg

Dr. Adrian Harel

Dr. Adrian Harel, PhD
Chief Executive Officer
Medicortex Finland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Every 15 seconds, someone in the United States suffers a new head injury. Of the 2.5M people treated in hospital emergency rooms each year, 80,000 become permanently disabled because of TBI. Currently, there are no reliable diagnostic tests to assess the presence or severity of an injury on-site, nor are there any pharmaceutical therapies that could stop the secondary injury from spreading. Accurate diagnostics would benefit especially mild cases of TBI (concussions), which, if occurring repeatedly, may cause neurodegenerative conditions such as Chronic Traumatic Encephalopathy (which is typical for athletes in NFL and Ice-hockey).

We have performed extensive preclinical research comparing fluid biopsies from normal and injured lab animals. The results showed some unique biomarkers released as a biodegradation products after head injury. The data served as the basis and confirmation for our patent applications to protect the biomarker concept.

Medicortex has completed a clinical proof-of-concept trial in collaboration with Turku University Hospital (Tyks). Samples from 12 TBI patients and 12 healthy volunteers were collected and analyzed for the presence and for the level of the biomarker in state-of-the-art laboratories. The study demonstrated the diagnostic potential of the new biomarker in humans and it confirmed the prior preclinical findings. This was a significant milestone for Medicortex.

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When Is It Safe To Drive After a Concussion?

MedicalResearch.com Interview with:

Julianne Schmidt, PhD, ATC Assistant Professor Department of Kinesiology The University of Georgia Athens GA

Dr. Julianne Schmidt

Julianne Schmidt, PhD, ATC
Assistant Professor
Department of Kinesiology
The University of Georgia
Athens GA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Less than half of all people with a concussion intend to reduce their driving at any point.

Current recommendations surrounding concussion focus on when it is safe to return to sport or return to the classroom, but return to driving is usually ignored and has not been studied.
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Early Participation in Physical Activity Following Acute Concussion in Children

MedicalResearch.com Interview with:

Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON

Dr. Roger Zemek

Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit,
Children’s Hospital of Eastern Ontario
Ottawa, ON

MedicalResearch.com: What is the background for this study?

Response: While current concussion protocols endorse the conservative view that children should avoid physical activity until completely symptom-free, there is little evidence beyond expert opinion regarding the ideal timing of physical activity re-introduction. In fact, while rest does play a role in concussion recovery, protracted physical rest may actually negatively impact concussion recovery. Further, physiological, psychological, and functional benefits of early physical rehabilitation are observed in other disease processes such as stroke (which is an example of a severe traumatic brain injury). Therefore, our objective was to investigate the relationship between early physical activity (defined within 7 days of the concussion) and the eventual development of persistent post-concussion symptoms at one month.

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Depressive disorders are the most frequent neuropsychiatric complication of TBI

MedicalResearch.com Interview with:

Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine

Dr. Ricardo Jorge

Ricardo E. Jorge  MD
Professor of Psychiatry and Behavioral Sciences
Director Houston Translational Research Center for TBI and Stress Disorders
Senior Scientist  Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry
Michael E DeBakey VA Medical Center
Baylor College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury. Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course.

Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients.

In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment.

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Sertraline May Prevent Depression Following Traumatic Brain Injury

MedicalResearch.com Interview with:

Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine

Dr. Ricardo Jorge

Ricardo E. Jorge MD
Professor of Psychiatry and Behavioral Sciences
Director Houston Translational Research Center for TBI and Stress Disorders
Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry
Michael E DeBakey VA Medical Center
Baylor College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury (TBI). Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course.

Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients. In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment.

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Younger Kids More Likely To Quickly Return to Sports After Concussion

MedicalResearch.com Interview with:

Zachary Y. Kerr, PhD, MPH Sports Injury Epidemiologist Director, NCAA Injury Surveillance Program Datalys Center for Sports Injury Research and Prevention Indianapolis, IN 46202

Dr. Zachary Keff

Zachary Y. Kerr, PhD, MPH
Sports Injury Epidemiologist
Director, NCAA Injury Surveillance Program
Datalys Center for Sports Injury Research and Prevention
Indianapolis, IN 46202

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Kerr: A 2013 Institutes of Medicine report called for more research on concussion in athletes aged 5-21 years.  Although there is much research on the incidence of concussion across this age span, there is less related to outcomes such as symptoms and return to play time, let along comparisons by age.

In examining sport-related concussions that occurred in youth, high school, and college football, we found differences in the symptomatology and return to play time of concussed players.  For example, the odds of return to play time being under 24 hours was higher in youth than in college.  Also, over 40% of all concussions were returned to play in 2 weeks or more.

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Subtle Postural Control Changes In Some Soccer Players After Heading

MedicalResearch.com Interview with:

Jaclyn B. Caccese MS The University of Delaware PhD Candidate Biomechanics and Movement Science

Jaclyn Caccese

Jaclyn B. Caccese MS
The University of Delaware
PhD Candidate Biomechanics and Movement Science 

MedicalResearch.com: What is the background for this study?

Response: Recently, there has been increased concern regarding the adverse effects of repetitively heading soccer balls on brain function. While some studies have shown impaired balance and vision, it is unclear if these deficits are acute or chronic adaptations. Therefore, the purpose of this study was to identify changes in postural control and vestibular/ocular motor function immediately following an acute bout of 12 purposeful soccer headers.

MedicalResearch.com: What are the main findings?

Response: The main finding of this study was that women’s soccer players showed an increase in sway velocity, but no other changes in balance or vestibular/ocular motor function were identified.

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Blood Biomarkers Can Help Evaluate Mild Concussion

MedicalResearch.com Interview with:

Linda Papa MD.CM, MSc, CCFP, FRCPC, FACEP Director of Academic Clinical Research Attending Emergency Physician Orlando Regional Medical Center Professor, University of Central Florida College of Medicine Associate Professor, Florida State University College of Medicine Adjunct Professor, University of Florida College of Medicine Adjunct Professor, Department of Neurology and Neurosurgery McGill University

Dr. Linda Papa

Linda Papa MD.CM, MSc, CCFP, FRCPC, FACEP
Director of Academic Clinical Research
Attending Emergency Physician
Orlando Regional Medical Center
Professor, University of Central Florida College of Medicine
Associate Professor, Florida State University College of Medicine
Adjunct Professor, University of Florida College of Medicine and Department of Neurology and Neurosurgery McGill University

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Papa:  The temporal profile of these biomarkers has never been examined in mild TBI/concussion patients before. Research has focused on severe traumatic brain injury (TBI) but not enough work has been done in mild TBI/concussion. GFAP and UCH-L1 had very distinct temporal profiles in this study. It was a very pleasant surprise that GFAP performed so well and performed so consistently throughout the 7 days after injury. This suggests that GFAP could be used for clinical decision making over a week post-injury. The early peak in UCH-L1 was very exciting but its rapid decline will limit its use at later time points.

1-     The biomarkers could be used to detect a mild traumatic brain injury/concussion in patients following trauma acutely (GFAP, UCH-L1) such as in the emergency department or urgent care clinic or perhaps in the prehospital setting. Notably, GFAP could also be used later (up to 7 days) in patients who may not seek immediate medical attention.

2-     The biomarkers could help with determining the need for a CT scan of the brain acutely (GFAP, UCH-L1) or after several days (GFAP). This is particularly important in younger patients who are more sensitive to ionizing radiation. It also has implications for hospitals in rural settings who may not have access to CT scans 24 hours/day.

3-     The biomarkers could help identify patients who may need neurosurgical intervention very early after injury so patients could be transported to facilities where neurosurgical care is always available.

Some specific scenarios in which these biomarkers would be particularly helpful include:

  •    In patients who are intoxicated with drugs or alcohol (because they are cognitively impaired).
  •   In patients with polytrauma who have multiple injuries (other injuries distract from potential brain injury).
  •   In elderly patients who cannot express their symptoms or in children who cannot express their symptoms (we examined children in a separate study published in Academic Emergency Medicine in Nov 2015).
  •   In athletes with head trauma during play.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Papa:  These data focus on mild TBI/concussion patients. Getting blood samples from these patients over time is very challenging but is extremely important because individuals with mild TBI/concussion can present at different times after injury. Some patients do not seek medical attention for several hours to days after their injury. GFAP appears to be useful both early and late after injury. UCH-L1 is only helpful early on. This study captures the real-world setting in which  traumatic brain injury biomarkers would be used by comparing a large number of trauma patients with TBI to a large number of trauma patients without a TBI. This study provides physicians with information about when and how these biomarkers could be used to evaluate trauma patients with suspected mild TBI/concussion.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Papa:    These data provide valuable information on the diagnostic accuracy of GFAP and UCH-L1 at 20 distinct time points over 7 days after head trauma. They reflect severity of brain injury (higher levels indicate more severe injury). As with other blood tests, these biomarkers are tools to complement clinical judgment. 

MedicalResearch.com: Is there anything else you would like to add?

Dr. Papa:  Physicians have access to many blood tests for different organ systems in the body such as troponin for cardiac ischemia, creatinine for kidney impairment, TSH for thyroid function, etc…. As of yet, there is no FDA approved blood test for  traumatic brain injury . These results support GFAP as a robust marker for mild TBI/concussion. These blood tests are being commercialized for FDA approval.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Papa L, Brophy GM, Welch RD, et al. Time Course and Diagnostic Accuracy of Glial and Neuronal Blood Biomarkers GFAP and UCH-L1 in a Large Cohort of Trauma Patients With and Without Mild Traumatic Brain Injury.JAMA Neurol. Published online March 28, 2016. doi:10.1001/jamaneurol.2016.0039.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com


Linda Papa MD (0). Blood Biomarkers Can Help Evaluate Mild Concussion MedicalResearch.com

Genetic Variation Affects Recovery From Concussion

MedicalResearch.com Interview with:

Dr. Jane McDevitt Temple University in Philadelphia

Dr. Jane McDevitt

Dr. Jane McDevitt
Temple University in Philadelphia

MedicalResearch.com: What is the background for this study?

Dr. McDevitt: During a head impact there is a mechanical load that causes acceleration and deceleration forces on the brain within the cranium. The acceleration and deceleration causes stress to the neurons and initiates a neurometabolic cascade, where excitatory neurotransmitters such as glutamate are released and depolarize the cell.  This triggers protein channels to open and allow ions into and out of the cell.  Increases in calcium persist longer and have greater magnitude of imbalance than any other ionic disturbance. One channel responsible for allowing calcium into the cell is r-type voltage-gated calcium channel.  One of the main proteins within this voltage-gated calcium channel is the CACNA1E protein produced by the CACNA1E gene. This protein forms the external pore and contains a pair of glutamate residues that are required for calcium selectivity.   It is also responsible for modulating neuronal firing patterns. A variation within this gene (i.e,CACNA1E ) that regulates expression levels of CACNA1E could be associated with how an athlete recovers following a concussion injury.

Upwards of 20% of the concussed population fall into the prolonged recovery category, which puts these athletes at risk for returning to play quicker than they should. Variation in recovery depends on extrinsic factors like magnitude of impact, and sport, or intrinsic factors like age or sex. One intrinsic factor that has not been definitively parsed out is genetic variation. Recovery is likely to be influenced by genetics because genes determine the structure and function of proteins involved in the cell’s resistance and response to mechanical stress. Due to CACNA1E’s relationship to calcium influx regulation, a single nucleotide polymorphism (SNP) could modify the expression level of the protein responsible for regulating calcium. Altered protein levels could lead to athlete’s responding to concussive injuries differently. The main objective of this study was to examine the association between CACNA1E SNPs with concussion recovery in athletes.

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Fewer Pediatric Abusive Head Trauma In States With Paid Family Leave

MedicalResearch.com Interview with:

Joanne Klevens, MD, PhD Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, Georgia

Dr. Joanne Klevens

Dr. Joanne Klevens, MD, PhD, MPH
Division of Violence Prevention
US Centers for Disease Control and Prevention
Atlanta, Georgia

Medical Research: What is the background for this study? What are the main findings?

Dr. Klevens: Pediatric abusive head trauma is a leading cause of fatal child maltreatment among young children and current prevention efforts have not been proven to be consistently effective. In this study, compared to seven states with no paid family leave policies, California’s policy showed significant decreases of hospital admissions for abusive head trauma in young children. This impact was observed despite low uptake of policy benefits by Californians, particularly among populations at highest risk of abusive head trauma.

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Adults With Concussion Have Increased Risk of Suicide

MedicalResearch.com Interview with:

Dr. Donald Redelmeier MD, MSHSR, FRCPC, FACP Senior core scientist at the Institute for Clinical Evaluative Sciences (ICES) Physician at Sunnybrook Health Sciences Centre Toronto, Ontario

Dr. Donald Redelmeier

Dr. Donald Redelmeier MD, MSHSR, FRCPC, FACP
Senior core scientist at the Institute for Clinical Evaluative Sciences (ICES)
Physician at Sunnybrook Health Sciences Centre
Toronto, Ontario

Medical Research: What is the background for this study? What are the main findings?

Dr. Redelmeier: Head injury can lead to suicide in military veterans and professional athletes; however, whether a mild concussion acquired in community settings is also a risk factor for suicide is unknown.

Medical Research: What should clinicians and patients take away from your report?

Dr. Redelmeier: We studies 235,110 patients diagnosed with a concussion and found that  667 subsequently died from suicide. The median delay was about 6 years. This risk was about 32 per 100,000 patients annually, which is 3x the population norm and especially high if the concussion occurred on a weekend (from recreation) rather than a weekday (from employment).
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Hypothermia Did Not Improve Outcomes After Traumatic Brain Injury

Prof. Peter JD Andrews Honorary Professor Department of Anaesthesia University of EdinburghMedicalResearch.com Interview with:
Prof. Peter JD Andrews
Honorary Professor
Department of Anaesthesia
University of Edinburgh 

Medical Research: What is the background for this study?

Prof. Andrews: Therapeutic hypothermia has shown considerable promise as a neuro-protective intervention in many species and models of cerebral injury in the laboratory. Clinical trials after neonatal hypoxic ischemic encephalopathy and cardiac arrest (global cereal ischemia) show signal of benefit.
The outcome after traumatic brain injury (TBI) has not improved in the last 20 years. Clinical trials of prophylactic therapeutic hypothermia for neuroprotection after traumatic brain injury show a mixed outcome, however, the larger trials are all neutral or have a trend toward harm.

Because traumatic brain injury is a heterogeneous pathology it has been suggest that the therapeutic hypothermia intervention should be adjusted according to response of a biomarker, to maximize benefit and limit any harms. The EUROTHERM3235Trial was a trial of therapeutic hypothermia to reduce brain swelling after traumatic brain injury. Brain swelling was measured by an intracranial pressure (ICP) probe directly inserted into the brain.

Medical Research: What are the main findings?

Prof. Andrews: Hypothermia successfully reduced intracranial pressure, but did not improve outcomes compared to standard care alone, with more than a third achieving a good outcome in the standard care group and one a quarter in the hypothermia group.

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Biomarker S100B Can Help Rule Out Hemorrhage After Minor Head Injury

Dr. Heinrich Thaler Trauma Hospital Meidling Vienna AustriaMedicalResearch.com Interview with:
Dr. Heinrich Thaler
Trauma Hospital Meidling
Vienna Austria

Medical Research: What is the background for this study?

Dr. Thaler:  An increased prevalence of minor head injuries in elderly patients combined with the frequent use of platelet aggregation inhibitors resulted in increased hospital admissions and cranial computed tomography. We undertook the study with the aim to reduce the workload of medical staff and costs as well as the radiation burden in the management of patients with mild head injuries.

Medical Research: What are the main findings?

Dr. Thaler:  S 100B is a reliable negative predictor in elderly patients and/or in patients on platelet aggregation inhibitors to rule out an intracranial hemorrhage after minor head injury (S100B is an astroglial derived protein detectable in serum in the case of cerebral tissue damage). The negative predictive value of S100B is 99,6%. We conclude that S100B levels below 0.105 µg/L can accurately predict a normal cranial computed tomography after minor head injury in older patients and those on antiplatelet medication. Additionally we found no increased risk for intracranial hemorrhage in older patients or in patients receiving antiplatelet therapy.

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Children With Traumatic Brain Injuries Can Have Poor Sleep Quality

MedicalResearch.com Interview with:
Kimberly Allen PhD, RN Assistant Professor
Center dr-kimberly-allenfor Narcolepsy, Sleep and Health Research
Department Women Children and Family Health Science
Chicago, IL 60612

Medical Research: What is the background for this study?

Dr. Allen: Pediatric traumatic brain injuries (TBI) are a leading cause of morbidity and mortality worldwide.Each year in the United States over 1Ž2 million children are admitted to the hospital for traumatic brain injuries (TBIs). Depending on the severity of the injury and how the individual child responds to the primary injury, a range of medical care may be necessary from an overnight hospital admission for observation to admission in the intensive care unit (ICU) and inpatient rehabilitation facility to re-teach and help to recover skills children once knew. The short- and long-term consequences of traumatic brain injuries include: motor and sensory impairments; cognitive, emotional, psychosocial impairments; headaches, and sleep disruptions.

Medical Research: What are the main findings?

Dr. Allen: The main finding from this pilot study with two groups with 15 children in each group: one of children with traumatic brain injuries and one of typically, developing healthy children was that children with traumatic brain injuries have significantly more daytime sleepiness and worse sleep quality compared to the control group. Additionally, children with TBI also had lower overall  functional scores (e.g, school, social) compared to the controlled children. All of the surveys were completed by the child’s parent.

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Law Brings More Student Athletes To ER For Sports-Related Concussions

Dr. Pina Violano, RN, PhD Trauma Department, Yale-New Haven Hospital, Injury Free Coalition for Kids of New Haven Yale-New Haven Children’s Hospital New Haven 06510, CTMedicalResearch.com Interview with:
Dr. Pina Violano, RN, PhD

Trauma Department, Yale-New Haven Hospital,
Injury Free Coalition for Kids of New Haven
Yale-New Haven Children’s Hospital
New Haven 06510, CT

MedicalResearch: What is the background for this study?

Dr. Violano: In July of 2012, Connecticut became one of the first states to enact legislation to ensure the safety and appropriate evaluation and management of sports-related concussions (SRC) among High School students. SRCs are a common occurrence in high school sports with their diagnosis increasing over the last decade. While the exact reasons are not known, public health campaign efforts and education may have facilitated improvement in the evaluation and detection of sports-related concussions and may have contributed to increase awareness and treatment.

MedicalResearch: What are the main findings?

Dr. Violano: Evaluation of two emergency department records revealed a marked increase in the frequency of high school student athletes being treated for sports-related concussions after the implementation of Connecticut’s SRC law. This suggests that Connecticut’s legislation is effective in improving the evaluation and detection of sports-related concussions in high school students.

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Brain Injury: Using Music Video Eye Tracking To Predict Recovery

Uzma Samadani, MD. PhD. FACS. Chief Neurosurgeon New York Harbor Health Care System Co-Director Steven and Alexandra Cohen Veterans Center for PTSD and TBI Assistant Professor Departments of Neurosurgery, Psychiatry and Physiology & Neuroscience New York University School of Medicine New York , NY 10010MedicalResearch.com Interview with:
Uzma Samadani, MD. PhD. FACS.
Chief Neurosurgeon New York Harbor Health Care System
Co-Director Steven and Alexandra Cohen Veterans Center for PTSD and TBI
Assistant Professor Departments of Neurosurgery, Psychiatry and Physiology & Neuroscience
New York University School of Medicine New York , NY 10010

Medical Research: What is the background for this study? What are the main findings?

Dr. Samadani: Eye tracking has been used for 30 years to investigate where people look when they follow particular visual stimuli.  Tracking has not, however, been previously used to assess underlying capacity for eye movement.  We have developed a very unique eye tracking algorithm that assesses the capacity of the brain to move the eyes.

What we show in this paper is that with our eye tracking algorithm we can show
(1) normal people have eye movements that, within a particular range, have equal capacity for vertical and horizontal movement,
(2) people with specific weaknesses of the nerves that move the eyes up and down have decreased vertical capacity,
(3) people with weaknesses in the nerves that move the eyes to the side have decreased horizontal capacity,
(4) swelling in the brain can affect the function of these nerves and be detected on eye tracking,
(5) eye tracking may be useful as a potential biomarker for recovery from brain injury.

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Marijuana May Be Protective Against Traumatic Brain Injury

David Plurad, MD Los Angeles Biomedical Research In
MedicalResearch.com Interview with:

David Plurad, MD
Los Angeles Biomedical Research Institute.


Medical Research: What are the main findings of the study?
Based on a survey of patients with traumatic brain injuries, a group of Los
Angeles Biomedical Research Institute researchers found those who tested
positive for tetrahydrocannabinol (THC), the active ingredient in marijuana, were more likely to survive than those who tested negative for the illicit substance.

We surveyed 446 patients who were admitted to a major urban hospital with
traumatic brain injuries between Jan. 1, 2010, and Dec. 31, 2012, who were
also tested for the presence of THC in their urine. We found 82 of the
patients had THC in their system. Of those, 2.4% died. Of the remaining
patients who didn’t have THC in their system, 11.5% died.

While most – but not all – the deaths in the study can be attributed to the
traumatic brain injury itself, it appears that both groups were similarly
injured. The similarities in the injuries between the two groups led to the
conclusion that testing positive for THC in the system is associated with a
decreased mortality in adult patients who have sustained traumatic brain
injuries.
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Post Concussion: Returning To Activity Brings Variable Risks

Li-Shan Chou, Ph.D Professor and Department Head Department of Human Physiology University of Oregon Eugene, OR 97403-124MedicalResearch.com Interview with:
Li-Shan Chou, Ph.D
Professor and Department Head Department of Human Physiology
University of Oregon Eugene, OR 97403-1240

Medical Research: What are the main findings of the study?

Prof. Li-Shan Chou: The findings from this study indicate that pre return-to-activity (RTA), the adolescents with concussion reduced their medial/lateral displacement and velocity during dual-task walking, suggesting an improvement in gait balance control, while significantly increasing these frontal plane motion variables during dual-task walking post RTA, suggesting a worsening of frontal plane COM control following RTA. These data suggest that frontal plane motion during dual-task walking are sensitive to the effects of return to activity following concussion and may reveal a possible regression in gait stability following return to activity.
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Post-Concussion Symptoms Mimic Post Traumatic Stress Syndrome

MedicalResearch.com Interview with: Emmanuel Lagarde Director of Research at INSERM, France  Medical Research: What are the main findings of the study?  Dr. Lagarde: Concussion accounts for more than 90 percent of all traumatic brain injuries, although little is known about prognosis for the injury. The symptoms cited as potentially being part of post concussion syndrome fall into three areas: cognitive, somatic and emotional. But the interpretation of symptoms after concussion should also take into account that injuries are often sustained during psychologically distressing events which can lead to Posttraumatic Stress Disorder.    Medical Research: Were any of the findings unexpected?  Dr. Lagarde: Yes, as we were expecting to observe long term (3-month) symptoms following brain injury, but few were found to be specific : most of them were as frequent among patients with other injuries.  Medical Research: What should clinicians and patients take away from your report?  Dr. Lagarde: It seems as if there is little evidence of the existence of a specific syndrome following mild traumatic brain injury. However, patients who experienced a concussion are at risk of  another well-known syndrome called Posttraumatic Stress Disorder, which is associated with the distressing event that led to the injury.  Medical Research: What recommendations do you have for future research as a result of this study?  Dr. Lagarde: The classification system of symptoms following mild brain injury should be revisited as our results are challenging the very relevance of the DSM-V post concussion syndrome.  Citation: Association of Symptoms Following Mild Traumatic Brain Injury With Posttraumatic Stress Disorder vs Postconcussion SyndromeMedicalResearch.com Interview with:
Emmanuel Lagarde
Director of Research at INSERM, France

Medical Research: What are the main findings of the study?

Dr. Lagarde: Concussion accounts for more than 90 percent of all traumatic brain injuries, although little is known about prognosis for the injury. The symptoms cited as potentially being part of post concussion syndrome fall into three areas: cognitive, somatic and emotional. But the interpretation of symptoms after concussion should also take into account that injuries are often sustained during psychologically distressing events which can lead to Posttraumatic Stress Disorder.

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Traumatic Brain Injury: Maintaining Hemoglobin With Transfusions or EPO Found Not Helpful

Claudia Robertson, MD Professor, Department of Neurosurgery Baylor College of Medicine One Baylor Plaza Houston, Texas 77030MedicalResearch.com Interview with:
Claudia Robertson, MD
Professor, Department of Neurosurgery
Baylor College of Medicine
One Baylor Plaza
Houston, Texas 77030

Medical Research: What are the main findings of the study?

Dr. Robertson: We studied two issues related to treatment of anemia after severe traumatic brain injury.

One issue was the optimal hemoglobin transfusion threshold for this subgroup of critically ill patients, and the second issue was use of erythropoietin to increase hemoglobin concentration and reduce the need for transfusion.  For the transfusion threshold, we found that there was no difference in long-term neurological outcome when patients were transfused at a hemoglobin concentration of less than 7 g/dl compared to those transfused at less than 10 g/dl.  In addition, there was an increased risk of thromboembolic events in those transfused at less than 10 g/dl.  With administration of erythropoietin, we found no improvements in neurological outcome, and no increase in hemoglobin concentration or reduction in the need for transfusion.

Medical Research: Were any of the findings unexpected?

Dr. Robertson: It has been believed that maintaining hemoglobin concentration at least 10 g/dl is an important management practice to reduce secondary injury to the brain.  This study does not support that practice.

Medical Research: What should clinicians and patients take away from your report?

Dr. Robertson: The major message is that patients with traumatic brain injury should be managed the same as other critically ill patients with a restrictive transfusion practice.  There is no advantage to maintaining hemoglobin concentration at a higher level, and there is some risk of transfusion related complications.  There is also no support from this study for use of erythropoietin in patients with traumatic brain injury.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Robertson: The findings with erythropoietin were disappointing because there have been many studies in experimental models of brain injury showing neuroprotection.  It is possible that we are not able to give high enough doses of erythropoietin in patients because of potential side effects and that derivatives of erythropoietin which do not have these side effects may still be of interest for future clinical trials.

Citation:

Tackle Football Linked to Smaller Hippocampal Volume and Slower Reaction Times

Patrick S. F. Bellgowan, PhD Laureate Institute for Brain Research Faculty of Community Medicine, The University of Tulsa, Tulsa, OklahomaMedicalResearch Interview with:
Patrick S. F. Bellgowan, PhD
Laureate Institute for Brain Research
Faculty of Community Medicine, The University of Tulsa,
Tulsa, Oklahoma


MedicalResearch: What are the main findings of the study?

Dr. Bellgowan: These results demonstrate 14% and 24% smaller hippocampal volumes in collegiate football players with and without a history of concussion relative to education-, sex- and age-matched controls participants.  Further, the number of years of tackle football experience was correlated with smaller hippocampi and slower baseline reaction times.  The hippocampus plays a key role in memory and emotional regulation.  Volumetrics of other medial temporal lobe structures (I.e. The amygdala) did NOT show differences among groups suggesting that this effect is localized to the hippocampus.
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Homeless Men: Association with High Rate of Prior Brain Injury

Jane Topolovec-Vranic, PhD Clinical Researcher, Trauma and Neurosurgery Program Associate Scientist, Li Ka Shing Knowledge Institute Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto Associate Member, Graduate Department of Rehabilitation Sciences, University of Toronto MedicalResearch.com Interview with:
Jane Topolovec-Vranic, PhD
Clinical Researcher, Trauma and Neurosurgery Program
Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto
Associate Member, Graduate Department of Rehabilitation Sciences, University of Toronto

MedicalResearch.com What are the main findings of the study?

Answer: In our study we found that almost half of the men interviewed in a homeless shelter in Toronto had experienced a traumatic brain injury in their past, and that most of them had experienced their first brain injury prior to becoming homeless, usually in the early teenage years.
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Sports-Related Concussion Diagnosis Using Blood Biomarker Tau

Pashtun Shahim, MD Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Department of Neurochemistry Sahlgrenska University Hospital, Mölndal SwedenMedicalResearch.com Interview with:
Pashtun Shahim, MD
Clinical Neurochemistry Laboratory
Institute of Neuroscience and Physiology
Department of Neurochemistry
Sahlgrenska University Hospital, Mölndal
Sweden

MedicalResearch.com: What are the main findings of the study?

Dr. Shahim: Sports-related concussion in professional ice hockey players is associated with acute axonal and astroglial injury. Plasma total tau, which is a highly central nervous system-specific protein, is a promising biomarker to be used both in the diagnosis of concussion and in the decision-making when an athlete can be declared fit to return to play.
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Traumatic Brain Injury Increases Risk of PTSD

Dewleen G. Baker, MD Department of Psychiatry School of Medicine, University of California, Veterans Affairs San Diego Healthcare System Veterans Affairs Center of Excellence for Stress and Mental Health San Diego, CaliforniaMedicalResearch.com Interview with:
Dewleen G. Baker, MD
Department of Psychiatry
School of Medicine, University of California,
Veterans Affairs San Diego Healthcare System
Veterans Affairs Center of Excellence for Stress and Mental Health
San Diego, California

MedicalResearch.com: What are the main findings of the study?

Dr. Baker: Pre-deployment psychiatric symptoms, combat intensity, and traumatic brain injury (TBI) were significant predictors of post-deployment PTSD symptom severity.  However, the strongest predictor was deployment-related TBI; mild TBI increased symptom scores by 23%, and moderate to severe injuries increased scores by 71%.
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Traumatic Brain Injury: Dietary Therapy

Miranda M. Lim, MD, PhD Assistant Professor, Sleep Medicine Division of Pulmonary and Critical Care Portland VA Medical Center and Oregon Health & Science UniversityMedicalResearch.com Interview with:
Miranda M. Lim, MD, PhD
Assistant Professor, Sleep Medicine
Division of Pulmonary and Critical Care
Portland VA Medical Center and Oregon Health & Science University

MedicalResearch.com: What are the main findings of the study?

Dr. Lim: People with traumatic brain injury (TBI) often have persistent sleep-wake disturbances including excessive daytime sleepiness and nighttime insomnia, yet the link between a hard blow to the head and drowsiness remains a mystery. We report that a dietary supplement containing branched chain amino acids helps keep mice with TBI awake and alert. The findings suggest that branched chain amino acids, something all humans produce from foods in their normal diets, could potentially alleviate sleep problems associated with TBI. In experiments with brain-injured mice that had trouble staying awake, we found that feeding the animals a dietary supplement enriched with branched chain amino acids improved wakefulness. Treated mice not only stayed continuously awake for longer periods of time, they also showed more orexin neuron activation, neurons known to be involved in maintaining wakefulness. (Previous studies have shown that people with narcolepsy lose significant amounts of orexins.) Branched chain amino acids are the building blocks of neurotransmitters, the chemicals released by neurons in the brain, including glutamate and GABA. We believe that branched chain amino acids act to restore the excitability of orexin neurons after brain injury, which could potentially promote wakefulness. Further studies are needed to pinpoint the exact mechanism of branched chain amino acids effect on sleep pathways in the brain, and to determine any side effects.
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Traumatic Brain Injury: PET Scanning to Detect Amyloid Deposition, Possible Dementia Risk

prof_david_menonMedicalResearch.com Interview with:
Prof David K Menon MD PhD FRCP FRCA FFICM FMedSci
Head, Division of Anaesthesia, University of Cambridge 
Consultant,
Neurosciences Critical Care Unit 
BOC Professor,
Royal College of Anaesthetists
Professorial Fellow, Queens’ College, Cambridge
Senior Investigator, National Institute for Health Research
Box 93, Addenbrooke’s Hospital, 
Cambridge CB2 2QQ, UK

MedicalResearch.com: What is the background for your study?

Dr. Menon: We have known for some time that a history of traumatic brain injury (TBI) results in a significant (between 2 and 10 fold) increase in the likelihood of getting dementia in later life.  On possible mechanistic explanation for this comes from the finding that about a third of individuals who died of TBI, regardless of age, are found at autopsy to have deposits of β-amyloid in the brain, often Aβ42, which is the same variant of amyloid seen in the brain of patients who have Alzheimer’s Disease.

However, such detection after death has made it impossible to examine the linkage of such early amyloid deposition to late dementia.  More recently, imaging with positron emission tomography (PET) and Pittsburgh compound B (PIB) has been used to image amyloid deposits in Alzheimer’s  Disease.  However, the technique had not been validated in traumatic brain injury.

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Depressive symptoms and white matter dysfunction in retired NFL players with concussion history

MedicalResearch.com eInterview with:

John Hart, M.D. Medical Science Director at the Center for BrainHealth Jane and Bud Smith Distinguished Chair Cecil Green Distinguished Chair The University of Texas at DallasJohn Hart, M.D.
Medical Science Director at the Center for BrainHealth
Jane and Bud Smith Distinguished Chair
Cecil Green Distinguished Chair
The University of Texas at Dallas

MedicalResearch.com: What are the main findings of the study?

Dr. Hart: Football players often sustain numerous concussive and subconcussive impacts—head impacts that do not elicit neurologic symptoms that may lead to white matter damage. We evaluated a population of retired NFL players in order to study the relationship between white matter integrity and the manifestation of depressive symptoms. We identified, for the first time, a correlation between depression and white matter abnormalities in former players with a remote history of concussion using diffusion tensor imaging (DTI).

Our data demonstrated a significant association between white matter integrity, as measured by DTI Fractional Anisotropy (FA), and the presence as well as severity of depressive symptoms in retired NFL athletes with a history of concussive or subconcussive impacts. We also found that dysfunction of the anterior aspect of the corpus callosum (forceps minor) and its projections to the frontal lobe can identify those with depression with 100% sensitivity and 95% specificity.

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Cognitive function and other risk factors for mild traumatic brain injury in young men

 Dr. Anna Nordström MD Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-901 87 Umeå, SwedenMedical Research.com Interview with
Dr. Anna Nordström MD

Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-901 87 Umeå, Sweden

Medical Research.com: What are the main findings of the study?

Dr. Nordström: We have found that low cognitive function and factors related to low socioeconomic status and intoxications are strong independent risk factors for mild traumatic brain injury in men.

Medical Research.com: Were any of the findings unexpected?

Dr. Nordström:  Our knowledge of risk factors that predispose people to sustaining such injury is limited. Previous research has inferred that mild traumatic brain injuries have important long-term consequences on cognitive function. However, we found similar deficits in cognitive function in subjects that sustained a mild traumatic brain injury before and after cognitive testing. Thus our data suggest that the injury itself may not reduce cognitive function.

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